Client Forms

In order to save time, you may print out and fill in your patient forms prior to your appointment. During your initial visit, we will need your client registration information as well as your medical history.

LifeCare files insurance claims on your behalf. All of our therapists are Licensed Professional Counselors and are able to accept medical insurance. Refer to your policy for a summary of mental health / therapy benefits as well as any limitations such as frequency of visits.

 

Download both Forms for Download and Consent for Services and Professional Disclosure.

Forms for Download (Privacy and Release Required):

Client Registration

 

Medical History

 

Privacy Practices (review only)

 

Release of Information (optional)

 

Consent for Services and Professional Disclosure

Please Choose the one for your counselor.

                                     

• April Miller
• Jerry Lankford
• William Venable
• Vanessa Kent
• Becky Jorgenson
• Deanna Towns
• Erin Bland